In Top Journal, Obamacare Boosters Push 'Global Spending Target'

Last year, the Obama administration held a series of nationwide “listening sessions” to solicit public input on what should be included in any “essential health benefits package.” One attendee at the Denver meeting noted well-orchestrated pitches from special interest groups seeking coverage for services including foster care for autism patients, HIV testing, and medical nutrition therapy for African-American patients.

In Massachusetts, the current mandatory insurance benefits package includes chiropractor services and in vitro fertilization -- services many ordinary people neither need nor want (but must pay for). In the proposed California essential benefits package, infertility treatments did not make the cut, but acupuncture did.

Under Obamacare 2.0, availability of health services will be increasingly driven by those with political “pull,” at the expense of those without.

3) The government will exert increasing control over how doctors can practice.

Under Obamacare, doctors will already be required to adhere to mandatory “quality measures” to be paid in full. The NEJM authors add a new twist, using the legal system to further control how physicians practice.

The NEJM article proposes a medical malpractice “safe harbor” where doctors “would be presumed to have no liability if they used qualified health-information-technology systems and adhered to evidence-based clinical practice guidelines.” In other words, if doctors follow government practice guidelines, they will be protected from malpractice lawsuits. But if doctors stray from those guidelines and anything goes wrong, they must take their chances in court. This will create tremendous pressure on physicians to practice government-approved “cookbook medicine.”

4) Controls breed controls.

Obamacare has explicitly encouraged hospitals and doctors to merge into large “Accountable Care Organizations.” Because these large entities face less competition in their local markets, health prices have naturally risen. In other words, Obamacare supporters are using these government-spawned monopolies to justify further government medical controls.

5) We need free-market reforms more than ever.

Instead of new government controls to “fix” problems caused by earlier controls, we need free-market health care reforms.

Note that pundits don’t debate whether to impose a national cap on private cellphone spending. That’s because our relatively free market has driven cellphone prices so low that even many of the poorest Americans can afford one.

The free market also works in health care. Consider “calcium scoring” heart scans, which measure how much calcium is deposited in the coronary arteries. Recent studies have shown these to be one of the safest and most reliable ways to measure one’s risk of future heart attack.

These calcium scoring scans do not require a doctor’s order and are not typically covered by insurance. Because patients generally pay out of pocket, motivated consumers shop around. Over time, normal market forces have dramatically driven down their price. Several years ago, they cost $500; now some centers offer them for under $100. This pattern of rising quality and falling prices can and should be the norm in all of health care.

Earlier this year, the U.S. Supreme Court upheld the constitutionality of the Obamacare “individual mandate.” This meant the government could now dictate how Americans must spend their own health care dollars. The proposed cap on private medical spending would also prevent Americans from spending their health care dollars as they wished. Obamacare 2.0 would mean unprecedented government control over our health care -- and our lives.